Treatment of Infections Caused by Gram-Positive Organisms

Significance of Gram-Positive Organisms

Gram-positive cocci and Gram-positive bacilli may require specific antimicrobial coverage, with some strains being susceptible only to vancomycin, according to the Infectious Diseases Society of America 1
The presence of multiple Gram-positive organisms suggests a potentially serious or polymicrobial infection that may not respond to standard empiric therapy, as noted by the Infectious Diseases Society of America 2

The Infectious Diseases Society of America recommends including vancomycin in the initial therapeutic regimen when cultures grow Gram-positive cocci and S. anginosus, especially in high-risk patients, with a strength of evidence rated as strong 1, 3
For patients in whom vancomycin may not be an option, the Infectious Diseases Society of America suggests considering alternatives such as linezolid, daptomycin, or ceftaroline, with a moderate level of evidence 3, 4
The American College of Clinical Pharmacy recommends that tedizolid (Sivextro) is specifically indicated for acute bacterial skin and skin structure infections caused by susceptible Gram-positive organisms including Streptococcus anginosus Group, although this is not directly cited in the provided text, it is a relevant guideline 4

The Infectious Diseases Society of America recommends a treatment duration of 7-14 days for most bacterial skin and soft tissue infections (SSTIs) 3
Surgical intervention for drainage should be considered if an abscess is present, especially after marrow recovery in neutropenic patients, as recommended by the Infectious Diseases Society of America 3, 4

Failing to adjust therapy when cultures reveal resistant Gram-positive organisms is a common pitfall, as noted by the Infectious Diseases Society of America, with a high level of evidence 4
Using narrow-spectrum antibiotics that don't adequately cover all identified pathogens is another pitfall, according to the European Society of Clinical Microbiology and Infectious Diseases, with a moderate level of evidence 5
Delaying appropriate treatment modification when a patient shows inadequate response to initial therapy is a pitfall, as recommended by the American Diabetes Association, with a low level of evidence 6